Copyright © 2003 by the European Society of Cardiology.
Letter to the Editor
Suggestions to improve the quality of life in heart failure
a Department of Medicine, Community Health Centre, Pondicherry 605 501, Mannadipet, India
b Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, 605 006, Pondicherry, India
* Correspondence to: Dr M. Thulasimani, Department of Medicine, Community Health Centre, Department of Medicine, Mannadipet, Pondicherry 605 501, India. Fax: +91 413 2272067
E-mail address: prakram{at}md4.vsnl.net.in
Received 7 February 2003; accepted 20 June 2003
We read with interest the study by Hobbs et al.1on ‘Impact of heart failure and left ventricular systolic dysfunction on quality of life’. The authors point out that given the poor prognosis of heart failure, quality of life should be a much more important target for management and suggest that enhanced use of ACE inhibitors and ß-blockers might improve quality of life; besides, treatment with positively inotropic phosphodiesterase may also be a supplement to the above target, but at the expense of increased mortality. Unfortunately, mention about the use of digoxin which has enjoyed the mainstay for more than two millenium has not been considered. Heart failure is the most expensive medical cause of hospitalization with readmission rate as high as 50% over 3 months. Since the aim of the authors is to improve the quality of life, combination of digoxin with diuretics will serve this purpose by improving the symptoms and decreasing hospitalization despite the absence of any significant effect onmortality.2
Chronic heart failure and atrial fibrillation are common and they commonly co-exist. The role of digoxin in these conditions has not been challenged.3Even in sinus rhythm, a reasonable approach is to use digoxin in those who remain symptomatic despite diuretic and ACE inhibitor treatment.
Though the authors’ conclusion is that ACE inhibitors significantly reduce progression to clinical heart failure, even with ACE inhibitor therapy, prognosis in heart failure remains grim. In young patients with symptomatic heart failure on ACE inhibitor therapy, 69% of the survived (35% mortality) warranted hospitalization within a span of 3.5 years. Effective new therapies are still desperately needed.4Therefore, we feel that exploring the possibility of primary prevention of heart failure could be better targetted. While ischaemic heart disease is the underlying cause in approximately 70% of all newly diagnosed heart failure patients, we suggest that measures toprevent atherosclerotic disease, plaque rupture and thrombosis must be undertaken. Additionally, administration of low dose aspirin as a measure of secondary prevention should be considered.
Concomitant pulmonary infection can also exacerbate or precipitate heart failure. Immunization against influenza annually and Pneumococci once may prevent heart failure and reducehospitalization.
It is also worth mentioning that carnitine, a neutraceutical has recently been shown to improve cardiac function and quality of life in patients with heart failure.5If this finding is substantiated, it may have a role in the future management of heart failure.
References
- Hobbs FDR, Kenkre JE, Roalfe AK et al. Impact of heart failure and left ventricular systolic dysfunction on quality of life. Eur Heart J. 2002;23:1867–1876 Doi: 10.1053/euhj 2002.3255.
[Abstract/Free Full Text] - Hisel T, Philips BB. Improving outcomes in congestive heart failure. Am J Health-Syst Pharm. 1999;56:1445–1450.
[Free Full Text] - Clark A. Digoxin in chronic heart failure. Clark AL, Mc Murray JJV. Heart Failure, Diagnosis and Management. London: Martin Dunitz Ltd; 2001. p. 91–100.
- Mc Murray J, Dargia H. Chronic Heart Failure. London: Martin Dunitz Ltd; 1998. p. 5–12 (eds).
- Rapport L, Lockwood B. Carnitine. Pharmaceut J. 2000;265:270–273.
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